Article Text

Original research
Public knowledge, attitudes and practices related to antibiotic use and resistance in Singapore: a cross-sectional population survey
  1. Jane M Lim1,2,
  2. Minh Cam Duong1,2,
  3. Alex R Cook1,2,
  4. Li Yang Hsu1,2,
  5. Clarence C Tam1,2,3
  1. 1 National University Singapore Saw Swee Hock School of Public Health, Singapore
  2. 2 National University Health System, Singapore
  3. 3 London School of Hygiene & Tropical Medicine, London, UK
  1. Correspondence to Dr Clarence C Tam; clarence.tam{at}


Objectives The WHO’s Global Action Plan on Antimicrobial Resistance (AMR) includes increasing overall public awareness of appropriate antibiotic use and resistance as a key priority area. We aimed to measure public knowledge, attitudes and practices of antibiotics and antibiotic resistance in Singapore, as well as their healthcare-seeking behaviours relating to respiratory illnesses, providing baseline data against which to measure the progress of future interventions.

Design A cross-sectional study.

Setting The general population in Singapore.

Participants Between May and June 2019, we conducted a survey via an online panel in Singapore with 706 respondents.

Results Our findings indicated common misconceptions surrounding antibiotic effectiveness and mechanisms of antibiotic resistance—most participants thought that resistance occurs when our bodies become resistant to antibiotics (62.5%) or when antibiotics become less powerful (48.5%). In multivariable analyses, better knowledge scores were associated with more favourable antibiotic attitudes (β=0.29; 95% CI 0.20 to 0.37). In addition, more favourable attitude scores were associated with lower odds of both expecting (OR: 0.84, 95% CI 0.72 to 0.99) and being prescribed antibiotics by a primary care doctor (OR: 0.76, 95% CI 0.63 to 0.90).

Conclusions This study presents important information about population perceptions towards antibiotics and antibiotic resistance in Singapore. Results from this study emphasise the importance of effective public communication strategies to promote responsible antibiotic use locally and should be used to inform future implementation of programmes and activities as laid out in Singapore’s National Strategic Action Plan on AMR.

  • public health
  • epidemiology
  • education & training (see medical education & training)

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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  • Contributors JML, MCD and CCT conceived the research study and developed the questionnaire. JML and CCT analysed the data and drafted the manuscript. ARC and LYH provided critical feedback on the manuscript.

  • Funding This work was funded by the Singapore Ministry of Health’s National Medical Research Council under the Centre Grant Programme–Singapore Population Health Improvement Centre (NMRC/CG/C026/2017_NUHS).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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